First, excellent post. Second, while it's all very neutered (to the extent possible, and rightfully so), anyone who has flown medevac and claims that they never pushed it *just a little bit* for the "mission" is either a liar or a monster.
I may have (may have) went to max continuous power on a flight when a lady coded in the back of the airplane in direct contravention of company policy requiring us to use some lower power setting - I was book legal, but not "operating in accordance with the GOM." I may have stopped my climb early (I was in VMC anyway) and told ATC I couldn't accept any vectors and made them scramble to reroute a myriad of HAL flights I wouldn't deviate for to get her on the ground more quickly. I may have landed long and rolled to the end to save time, probably in excess of the company taxi speed.
She died in the back of the airplane before we could offload her anyway. But I tried to do everything in my power to get her where she needed to be. I don't know how I could have lived with myself if I had done otherwise.
Most flights were not that exciting, and most of the time, it was the easiest job I've ever had, and yeah, there may have been better judgment I could have used in that particular moment. Thinking back on that exact flight, I could have flown a more standardized / squared off pattern, not taxied at 40+ kts down the runway. In hindsight, her survival was out of my hands; I could have just flown my flight planned route, I maybe saved 50 seconds lol and inconvenienced the hell out of HCF.
That's really hard to think about / do when the whole plane is wiggling around as the medics give chest compressions and the blood is pounding in your ears or when someone is creaming bloody-murder, or when it's a kid. I am fortunate that the weather was great and smooth, and it wasn't at night in a snowstorm in Nevada.
People can talk a big game about how the PIC in question "should" not have gone in the first place, but I challenge anyone to doom someone to certain death in front of the family members because the weather is crummy. Until we know more about the flight, the patient, the passenger etc. we should be cautious about being too critical of the pilot.
You're not supposed to know "how sick" the patient is, or "how critical" things are... but sometimes it's pretty obvious.